Effects of acute stress on executive functions in depression, generalised anxiety and borderline personality disorder

Background: Acute stress adaptively alters executive functions (EFs) essential for emotion regulation. Emerging systems of psychiatric classification, such as the Hierarchical Taxonomy of Psychopathology (HiTOP) and the Research Domain Criteria, emphasise the underlying mechanisms and dimensional nature of psychopathology. Distress disorders—a subfactor within the HiTOP model including major depressive disorder, generalised anxiety disorder and borderline personality disorder—are characterised by altered stress reactivity, impaired emotion regulation, and modest responsiveness to first-line psychotherapies. This systematic review sought to examine whether distress disorders and their related symptoms confer heightened vulnerability to transient EF impairment under conditions of acute stress. Methods: A comprehensive search of articles published in ProQuest, PsycINFO, PubMed, Scopus and Web of Science prior to December 31st, 2022 identified 17 suitable studies examining stress-induced alterations to working memory, inhibition and cognitive flexibility in the context of distress disorders and associated symptoms. Results: This review found a heightened susceptibility to stress-induced impairment of working memory in depression, and of response inhibition in borderline personality disorder—even for sub-clinical presentations of depressive symptoms wherein diagnostic criteria for a depressive disorder were not met. Findings for cognitive flexibility were inconclusive. Limitations: While a thorough systematic review was conducted, heterogeneity in study design and methodologies precluded inclusion of a meta-analysis. Conclusions: The findings indicate that altered stress reactivity leads to maladaptation of EF under acute stress, and subsequent disruption of adaptive emotion regulation strategies. The present finding may help account for non-responsiveness among therapeutic interventions predicated upon cognitively-demanding emotion regulation strategies.